Acupuncture typically takes place in an outpatient setting, such as a clinic or physician’s office.  During the initial visit the practitioner will collect the patient’s medical history to determine possible contributing factors. The practitioner will discuss the patient’s area of complaint, current medical condition, lifestyle and behavior. Patients should inform the acupuncturist of medications and additional treatments being used for the condition, particularly for pain.

A physical examination will then be performed to assess the patient’s status. In traditional Chinese medicine (TCM) practitioners often examine a patient’s tongue for abnormalities in shape, color and coating. The color and texture of the skin may also be noted, in addition to the patient’s posture. The acupuncturist will measure the patient’s pulse at several points along the wrist. Posture, pulse rate and the condition of the tongue and skin are believed to provide clues to a person’s health. Information collected during the medical history and findings from the physical exam will determine the acupuncture points that will receive stimulation.

After the examination, the patient will be asked to lie on a table. Depending on where the needles are going to be placed, patients may be told to lie on their back or on their stomach. They may also be instructed to loosen or remove some clothing. This allows the patient to get comfortable and uncovers areas that will be treated.

The acupuncture points are then sterilized with alcohol or another disinfectant. Disposable, one-time-use, sterilized needles are required by law in most states. These needles are inserted at specific points in the body. Patients may require anywhere from one or two needles to 20 needles. Usually fewer than a dozen needles are inserted. The number of needles required is based on the condition being treated.

Each needle is twirled or gently jiggled as it is placed to achieve the correct stimulation. They may be placed just under the skin or as deep as three inches (eight centimeters). The depth each needle is inserted is dependent on the location on the body and the condition being treated.

The needles are not necessarily placed in the area of pain. For example, pain or problems noted in the liver may use an acupuncture point in the leg or foot. Also, placement in one area often stimulates feeling in another part of the body.

Most patients feel no pain or minimal discomfort as the needles are inserted. Patients may feel a pinch or sting accompanied by a sensation of warmth or tingling. However, this minor discomfort should last only a few seconds. Patients should notify the acupuncturist if the pain persists. 

Acupuncture needles can be left in place for a few minutes or up to an hour. For some treatments, the acupuncturist may insert and remove the needle for stimulation rather than leave it in place. In most cases, however, the needles are left in place for 15 to 30 minutes.

During this time, the acupuncturist will periodically check the patient’s comfort level. The practitioner may also move or manipulate the needles to stimulate the acupressure points. Many people find the treatment to be energizing, whereas others have reported a relaxing effect.

At the end of the session, the acupuncturist quickly and painlessly removes each needle. The one-time-use needles commonly used in the treatment will be disposed.

Depending on the condition being treated, the acupuncture needles may be heated, incorporating thermotherapy. A technique known as moxibustion requires the acupuncturist to light a small bunch of dried herbs (moxa). The herbs are then held above the needles without touching the skin. The moxa, which consists of the herb mugwort, burns slowly, releases a small amount of smoke, and produces an incense-like odor. Warm moxa also may be applied directly to the skin instead of needles for stimulation.

In some cases, electrical wires may be attached to the acupuncture needles, incorporating electrical therapy. A weak current is then sent to the needles to stimulate the acupuncture points. This can cause a mild tingling or no sensation at all.

After an acupuncture treatment, patients often feel more relaxed than usual. It is also common for patients to note a general change in appetite, bowel or urination habits and sleep patterns. This is thought to be related to having energy redirected and flowing more freely in the body.

An initial acupuncture session typically lasts an hour and a half, with weekly or biweekly follow-up sessions lasting 30 minutes to an hour. Treatment may take place over a few days, several weeks or longer. Patients with a single condition usually require six to 12 sessions spread out over several months.

Patients and their acupuncturist will decide the number of treatments required and the frequency of sessions. The number of sessions required is often based on the patient’s overall health and the condition being treated. Long-standing and complicated conditions often require more sessions. Patients taking certain medications (e.g., corticosteroids, tranquilizers, antidepressants) may also require more sessions.

Patients should ask the acupuncturist about the number of sessions required for their particular condition before starting the treatment. There have been cases of patients getting many treatments with minimal or no improvement.

Patients respond differently to acupuncture. Some patients report an immediate and strong effect after treatment, whereas others with the same disease or symptom may not notice a difference until several sessions have been conducted. In addition, many people who try acupuncture report no effect.